Over a third of pregnancies in city’s fringes classified as high-risk

Chennai: More than one in three pregnancies in Poonamallee carried a significant medical risk last year, according to a study by Tamil Nadu Directorate of Public Health and Preventive Medicine.Published in the latest edition of Tamil Nadu Journal of Public Health and Medical Research, the study found that 38.1% of pregnancies in peri-urban area were classified as high-risk, and that conditions driving maternal risk have shifted from haemorrhage and sepsis to thyroid disorders and repeat C-sections.The study examined 9,426 pregnancies registered between April 2024 and March 2025 across Poonamallee health unit district in Tiruvallur, on PICME — the state-run digital registry that tracks pregnancies and infant health outcomes across TN from registration through delivery. Of these, 3,593 women (38.1%) were classified as high-risk, with the burden falling more heavily on women in the urban Avadi Corporation area, where the rate climbed to 53%.Hypothyroidism was identified in 26.1% of high-risk cases, followed by a prior caesarean delivery (18.4%), gestational diabetes (10.2%), and pregnancy-induced hypertension (6.7%). Nearly 32.2% of high-risk women had two or more of these conditions simultaneously — a sign, researchers said, that chronic disease has quietly reshaped risks of pregnancy in urban India. The authors noted that the leading causes of maternal death and high-risk pregnancy were once direct obstetric emergencies — haemorrhage, sepsis, obstructed labour, and eclampsia — acute, event-driven crises that strike during or immediately around delivery.Tamil Nadu built its celebrated maternal health system — including its maternal death audit programme, running since 2004 — largely to confront these emergencies. The state’s success in driving down those acute causes has revealed a second, quieter layer of risk that was always present but is now dominant: chronic medical conditions that a woman carries into pregnancy. “The findings reaffirm Tamil Nadu’s epidemiological transition in maternal health — from predominantly obstetric causes to a combination of obstetric and medical conditions complicating pregnancy,” the authors wrote.The caesarean section rate among high-risk pregnancies reached 64.5% — nearly double of Tamil Nadu’s already-high statewide rate of 36.3% reported in National Family Health Survey. The study’s authors attributed this partly to large share of women with previous C-sections, for whom repeat surgery is typically recommended.Despite high medical complexity, outcomes for newborns were comparatively favourable. Live births accounted for 99.7% of all deliveries, and low birth weight was recorded in 15.6% of neonates, similar to the state average of 15.4% — a result the researchers credit to the area’s network of govt and empanelled private facilities. Even so, a rising burden of high-risk pregnancies can increase complications, treatment costs including out-of-pocket expenditure, and pressure on government health resources.While the Sample Registration System puts Tamil Nadu’s maternal mortality ratio for 2021–23 at 35 per 1lakh live births — second lowest in India after Kerala and Andhra Pradesh, both at 30 — public health experts are calling for integrating non-communicable disease screening into routine antenatal care. “The high prevalence of high-risk pregnancies calls for strengthened antenatal risk stratification, integration of non-communicable disease screening into routine antenatal clinics, focused counselling for women with previous C-sections, and continuity of care through referral linkages,” the authors wrote.